Original Title: Efectividad, seguridad y evaluación económica de las diferentes alternativas existentes en la detección precoz de problemas de visión en la edad pediátrica.

Authors' objectives: The aim of this review is to assess the available information related to the efficiency, effectiveness and safety of the screening for visual impairment in the paediatric population.

Authors' results and conclusions: The studies focus on screening of ambyopia and its risk factors. For the first research question (efficiency), a total of 379 studies were retrieved of which 9 economic evaluations were finally included. These studies differ in important design characteristics like the type of analysis (cost-effectiveness, costutility, and cost benefit), the time horizon, the screening strategies assessed or the threshold of visual acuity used, thus making direct comparisons difficult. No economic evaluations were found about the screening in the neonatal period to detect eye disorders like nystagmus, absence of a red reflex, leucocoria, ocular malformations, ptosis and photophobia. Evidence suggests that the cost per case detected from preschool screening (3 – 4 years old) of amblyopia and its risk factors is relatively low. However, this result is difficult to interpret as the utility loss (quality of life) derived from monocular visual loss due to amblyopia is unknown. Longterm horizon studies show that screening is cost-effective (programme costs per QALY gained) only when a reduction in utility due to permanent monocular vision impairment is assumed. For the second research question (effectiveness), a total of 379 studies were retrieved of which a systematic review conducted by the U.S. Preventive Services Task Force (USPSTF) was included. No randomized control trials about the effectiveness and safety of childhood vision screening in terms of morbidity reduction were identified. The studies included in the USPSTF, most of them of low quality, suggest that screening is significantly associated with an absolute reduction in the prevalence rate of amblyopia. No study was found that focus on the effects of screening on school performance and quality of life. There is no evidence about the impact of vision screening during the neonatal period. An expert consensus suggests that a check-up discarding congenital eye conditions should be performed within the first 3 months from birth.

Authors' recommendations: We recommend screening all children between 4 and 5 years of age for amblyopia, at least once, by age-appropriate optotypes. In newborn (1 – 28 days), we recommend to perform ocular physical examination and the red reflex test in order to detect severe eye disorders (microphthalmia, cataracts, glaucoma, aniridia, retinoblastoma, retinal abnormalities, severe refractive errors, etc.).

Authors' methods: The following databases were searched: PubMed/MEDLINE, EMBASE, Lilacs; and the databases of the Centre for Reviews and Dissemination (CRD): NHS Economic Evaluation Database (NHS EED), Health Technology Assessment Database (HTA), Database of Abstracts of Reviews of Effects (DARE). In addition, the databases of the following government agencies and scientific societies were also searched: U.S. Preventive Services Task Force, UK National Screening Committee, German Institute for Quality and Efficiency in Health Care (IQWiG), Canadian Task Force on Preventive Health Care, American Academy of Pediatrics, Canadian Paediatric Society, Asociación Española de Pediatría y Asociación Española de Pediatría en Atención Primaria. Subsequently, a manual search from the reference lists of previously identified references was conducted. Complete economic evaluation studies, experimental and observational studies with a comparison group published until April 2013, were selected for the review. No limits were applied for language. The selection of studies was done according to the previously defined inclusion and exclusion criteria. Those articles that met inclusion criteria were assessed by the computer-assisted critical appraisal tool of the Basque Office for Health Technology Assessment-OSTEBA.

Project Status: Completed

Year Published: 2016

URL for published report: https://www.iacs.es/wp-content/uploads/2017/04/760_IACS_Problemas_Vision.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Health Sciences Institute in Aragon (IACS)

Contact Address: Avda, San Juan Bosco, 13, planta 2

Contact Name: María Pilar Calvo Pérez

Contact Email: direccion.iacs@aragon.es